Predicting urinary incontinence after surgery for pelvic organ prolapse.

PURPOSE OF REVIEW: Many women choosing to have surgery for pelvic organ prolapse also choose to undergo continence surgery. This review focuses on available evidence that clinicians may use to counsel patients when choosing whether to perform continence surgery and how predictive analytic tools improve this decision-making process.

RECENT FINDINGS: Midurethral sling, Burch cystourethropexy and bladder neck sling are highly effective for the surgical treatment of stress urinary incontinence. Trials demonstrate that continence surgery may be routinely performed to reduce the risk of postoperative incontinence in women undergoing surgery for pelvic organ prolapse with or without preoperative stress urinary incontinence. Although these procedures are effective and well tolerated on average, media concerns, regulatory warnings and litigation reinforce the need for a balanced discussion regarding efficacy and potential adverse events directed at the individual patient during the preoperative visit. Advances in predictive analytics allow surgeons to quantitate individual risk using algorithms that tailor estimates for the individual patient and facilitate shared understanding of risks and benefits. These models are less prone to cognitive biases and frequently outperform experienced clinicians.

SUMMARY: This review discusses how predictive analytic tools can be used to improve decisions about continence surgery in the woman planning to undergo prolapse surgery.